Filing a complaint with the Medical Board

[abaga]

What is the name of your state (only U.S. law)? I live in Georgia

I was in the hospital for surgery and ended up two weeks after surgery with a staph infection. About two weeks after that, I was then diagnosed with two PE's. I was being followed by a hospitalist. The day I was being discharged, since I was going home on a blood thinner, I asked my nurse about foods I should avoid, meds to avoid, etc. She said that was a great question and she would go get the MD to come back and talk with me. Well, the nurse came back and said, "The Dr. said those are great questions, however, she has already been in here once today, and is not coming back!" So, I went home, and did some research on the computer and called a friend of mine who is a RPh.

Well, about a week or so later, I was having a lot of pain in my lung. I went to the ER and was admitted because my O2 SAT was low, I was in a lot of pain uncontrolled by my meds at home, and because my INR was sub therapeutic. The morning after being admitted, in walks the same hospitalist from the previous stay. She looks at me and says, "We need this bed for sick people, you are not sick, so you need to leave right now!" I told her I was on Oxygen. She told me that was for my comfort, for which I agreed as it was making it easier to breathe. I then told her my INR was sub therapeutic. She told me she would increase my Coumadin and that would be fine. She told me to continue the pain meds at home. So, I left. She also told me that one of the PE's dissolved (in one week it dissolved???).

Several days later, my nurse came to see me at home and I told her about the ongoing pain and shortness of breath. She calls my internist who had me to go the ER immediately as he felt I had another PE. I go to another hospital, and sure enough, there is a new PE AND a DVT, which they feel formed when I was sub therapeutic. Further, the new hospital did get a hold of the records from my previous hospitalization which showed I had two PE's at that time! So, NOTHING dissolved. Also, my INR this time was at 6.6!

I have been told by several MD's I never should have been discharged without a follow up INR the next day to make sure the increase in Coumadin was not too much. Also, if she felt the urge to discharge me, I should have been on something such as Lovenox until my INR was stable. This was not done..not by her at least (this was done by my Hematologist after the third PE and DVT was diagnosed)!! I had even asked her to call in a Hematologist when the two PE's were diagnosed initially and she refused to do that.

I realize because I did not die, there is not a malpractice case. Several of the MD's that are involved now, even at the old hospital where the disaster occurred, have said I need to file a complaint with the medical board. I have done this, but will it really matter? I do know she has, through her atty, requested my medical records so that she can review them. She is no longer with the hospital where the took place, so she does not have access to them at all.

I've always been told, if a Dr. does not have any complaints against them, they usually just file the complaint away and won't do anything with it unless something else comes up. Is this really true? How long does the process take to fully investigate? Do you feel there is misconduct on her part? Other MD's have said she doesn't need to be practicing medicine if this is how she takes care of people. One of my MD's was adamant that I file a complaint. It is really scary enough to think I could have died from having three PE's, but to have a Dr. have the attitude such as this hospitalist is really scary to think about!

I apologize for the length of this post. I just wanted to make sure I had as much information here as possible.

 

[Proserpina]

Please wait for one of the more experienced volunteers to respond; all I wanted to say really was that the fact that you did not die does not automatically preclude a malpractice suit.

Don't think that simply because you didn't die, you have no recourse.

 

[abaga]

Please wait for one of the more experienced volunteers to respond; all I wanted to say really was that the fact that you did not die does not automatically preclude a malpractice suit.

Don't think that simply because you didn't die, you have no recourse.

I spoke with a couple of med mal attys and each of them told me while there was negligence on the part of the Dr, since I did not die, it would not be beneficial cost wise to sue. They said it would cost between 60K and 70K, and what we would get out of it, if anything at all, would not be much more. One even told me if I did not win, I would be responsible for paying back all of the money paid out and any other fees as well (attys fees, copying fees, filing fees, etc.).

I do appreciate your input, Dogmatique! Thank you very much.

 

[lya]

There is much going on here that abaga does not recognize.

Let's start with the PE that developed during a hospital stay: No longer is the hospital paid by Medicare or Medicaid for treating this condition; it's out of their pocket. So, they will discharge a patient ASAP, ready or not. It will not be long before insurance payment follows M/M protocol and refuses to pay. In fact, insurance payment is already being adjusted downward.

Same for the staph infection that developed after surgery and while the patient was in the hospital.

Obviously, Home Health or some kind of Home Nursing care was ordered. It is and was the responsibility of the admitting RN to make sure proper PT/INR labs were ordered, obtained, reported, and followed-up with Coumadin dose changes or not. Dietary teaching is also the responsibility of the home care nurse.

The 'several days' later the RN came to see you at home is against standards of care. There is a 24 hour window in which the initial assessment must be completed.

It blows my mind that a nurse does not know the dietary needs of a patient on anticoagulant therapy and makes such a stupid statement as having to ask the MD, who doesn't have a clue because that's generally a nursing or pharmacist responsibility.

The pharmacist is required to visit the patient in the hospital and do Coumadin discharge teaching before the patient is discharged. Some Physician Extenders (RNs) do this teaching in lieu of the pharmacist' doing it and some RNs do the teaching, depending on the needs of the hospital, the other patients, and who is available. It remains the responsibility of the pharmacy to insure that it is done, which means it is the responsibility of the discharging RN to make sure it has been done.

Clots can and do clear in a few days or even less; they can also be in the process of resolving and recur. I'd have to see the films to know which occurred or even if it did occur (resolving).

One does not start Coumadin therapy and back up to Lovenox, which is a low molecular form of Heparin. The treatment regimen goes: Heparin IV, weaning Heparin while instituting Lovenox, beginning Coumadin, ending with Coumadin alone.

The hospital can't justify keeping a patient in the hospital for Lovenox treatment and Home Health reimbursement won't cover sending an RN to give an injection that the patient can do without an RN's being present. Home Health reimbursement is trying to get out of paying for PT/INR lab draws, too. The RN has to find an additional area of skilled RN need to get the RN in the home and to gain reimbursement. Of course, I am speaking of Medicare/Medicaid; each insurance policy has its own guidelines for reimbursement but all follow Medicare/Medicaid payment guidelines at least to some extent.

Oxygen therapy does not justify hospitalization. Oxygen therapy can be done at home. A durable medical equipment company will deliver an oxygen concentrator and a back-up "tank" of oxygen. The RN will monitor this at home care visits.

As for your dietary needs: don't change from your usual diet. If you normally eat a bowl of greens every day, don't stop. If you do not regularly eat greens, don't start. The main thing to remember is, if you change your diet in any way, be sure to tell your physician or home care nurse. Otherwise, don't worry about your diet and taking Coumadin.

You did not suffer additional costs related to your hospitalizations, so there is really nothing to recover for damages; and, I don't see any damages, anyway. You received shoddy care from a physician who no longer works at the facility, so some kind of corrective action has been taken. Somewhere in there, you encountered a stupid nurse; for that, I apologize on behalf of nurses everywhere. We are better than that; but, a few idiots do manage to pass the boards and become licensed.

 

[abaga]

First of all, what does Medicare and Medicaid have to do with this? I am not on either one.

Further, I was seen by a nurse the day after discharge. a PT/INR was NOT ordered by the MD to be done until the following week! The orders were there, but the MD would not change them!

I too felt the nurse should have known the answers to my questions, but since part of my question was around medication I was already on, she felt it was best for the MD to see me. Yes, a Pharmacist is supposed to see the patient, but that was not the case for me, Lya!

I find it interesting that you do not think Lovenox and Coumadin are given together. You are the only person thus far to say that! I was started on Lovenox and within two days of the initial PE's being found, the Lovenox was stopped. Everything I have been told since and have read states one should use Lovenox or Arixtra as a bridge until the coumadin levels are stable.

I do not recall saying I should have been kept in the hospital for lovenox therapy. I know how to give myself injections and would have done just fine giving them to myself (I am doing that now as I am on Arixtra. Just an FYI but my INR/PT levels were all over the board so I am on the Arixtra as it is more stable). This however, was not even offered to me. Home Oxygen was also not offered to me. I don't know if you've ever had a PE, Lya, but they are very painful...especially when you have three that are rather large (according to the MD's treating me). The pain medication I was using at home was not working. Had it been, I would not have gone to an ER again!

As for the clots resolving or having resolved. The MD's saw the films when the third PE was diagnosed. NOTHING had resolved or started resolving. Everything was the same.

Finally Lya, I was not even asking about MALPRACTICE. I think I actually said I knew I could not sue as it was not advantageous to an atty to do so. I was asking other questions about filing a COMPLAINT with the medical board.

I am always very nice when responding to answers to any questions I have posted in the past, however, I feel your post is more of an attack of everything I may have written. YOU made assumptions. It was not me not being able to recognize various points. I am very well aware of how medicare reimburses as I was once on medicare (am not now and haven't been for over six years). I don't know why you are assuming that I am. I am on a very good insurance plan that I pay about 400.00 a month for the coverage I do have.

So, if you'd like to reply to the questions I did ask, feel free, otherwise, maybe you should just refrain from writing anything else.

There is much going on here that abaga does not recognize.

Let's start with the PE that developed during a hospital stay: No longer is the hospital paid by Medicare or Medicaid for treating this condition; it's out of their pocket. So, they will discharge a patient ASAP, ready or not. It will not be long before insurance payment follows M/M protocol and refuses to pay. In fact, insurance payment is already being adjusted downward.

Same for the staph infection that developed after surgery and while the patient was in the hospital.

Obviously, Home Health or some kind of Home Nursing care was ordered. It is and was the responsibility of the admitting RN to make sure proper PT/INR labs were ordered, obtained, reported, and followed-up with Coumadin dose changes or not. Dietary teaching is also the responsibility of the home care nurse.

The 'several days' later the RN came to see you at home is against standards of care. There is a 24 hour window in which the initial assessment must be completed.

It blows my mind that a nurse does not know the dietary needs of a patient on anticoagulant therapy and makes such a stupid statement as having to ask the MD, who doesn't have a clue because that's generally a nursing or pharmacist responsibility.

The pharmacist is required to visit the patient in the hospital and do Coumadin discharge teaching before the patient is discharged. Some Physician Extenders (RNs) do this teaching in lieu of the pharmacist' doing it and some RNs do the teaching, depending on the needs of the hospital, the other patients, and who is available. It remains the responsibility of the pharmacy to insure that it is done, which means it is the responsibility of the discharging RN to make sure it has been done.

Clots can and do clear in a few days or even less; they can also be in the process of resolving and recur. I'd have to see the films to know which occurred or even if it did occur (resolving).

One does not start Coumadin therapy and back up to Lovenox, which is a low molecular form of Heparin. The treatment regimen goes: Heparin IV, weaning Heparin while instituting Lovenox, beginning Coumadin, ending with Coumadin alone.

The hospital can't justify keeping a patient in the hospital for Lovenox treatment and Home Health reimbursement won't cover sending an RN to give an injection that the patient can do without an RN's being present. Home Health reimbursement is trying to get out of paying for PT/INR lab draws, too. The RN has to find an additional area of skilled RN need to get the RN in the home and to gain reimbursement. Of course, I am speaking of Medicare/Medicaid; each insurance policy has its own guidelines for reimbursement but all follow Medicare/Medicaid payment guidelines at least to some extent.

Oxygen therapy does not justify hospitalization. Oxygen therapy can be done at home. A durable medical equipment company will deliver an oxygen concentrator and a back-up "tank" of oxygen. The RN will monitor this at home care visits.

As for your dietary needs: don't change from your usual diet. If you normally eat a bowl of greens every day, don't stop. If you do not regularly eat greens, don't start. The main thing to remember is, if you change your diet in any way, be sure to tell your physician or home care nurse. Otherwise, don't worry about your diet and taking Coumadin.

You did not suffer additional costs related to your hospitalizations, so there is really nothing to recover for damages; and, I don't see any damages, anyway. You received shoddy care from a physician who no longer works at the facility, so some kind of corrective action has been taken. Somewhere in there, you encountered a stupid nurse; for that, I apologize on behalf of nurses everywhere. We are better than that; but, a few idiots do manage to pass the boards and become licensed.

 

[lya]

You are hopeless and helpless.

I shall refrain from answering you further.

 

[ecmst12]

Your question isn't really clear. Of course you should file a complaint.

 

[abaga]

You are hopeless and helpless.

I shall refrain from answering you further.

Excuse me?? How am I hopeless and helpless?? YOU did not even read my question correctly. Had you, you would not have responded in such the way you did!

First, show me where I asked anything about if I had a malpractice case?? Please, show me! You won't be able to find that because I never asked it! Please, show me where I said anything about medicare and medicaid? Again, you won't find that because I don't have either one!

I will have to go back and read your other responses to see if this is your way of answering everyone that posts questions here. If so, then maybe you need to refrain from answering anyone from here on out!

 

[abaga]

Your question isn't really clear. Of course you should file a complaint.

Thank you, ecmst12.

I have filed the complaint. Do you think it will be taken seriously? I know it should be, but I have been told if there aren't any other complaints already on file, they will usually just file my complaint away. IF anything comes up again with this particular MD, then they will start an investigation. I guess I am not clear on that part. Is this truly the case in most instances or do they look at each complaint and investigate each complaint thoroughly?

I am in my 40's and have never filed a complaint against an MD in my life. I knew something had to be done with this MD, however, it was still a difficult thing for me to do. It wasn't until my MD told me to go home and do so immediately that I did it. When I told my other MD who works at the hospital where this MD WORKED, he told me he was happy to hear that she was no longer with them and also was happy to hear I did file the complaint.

I honestly do not care that I can't file a med mal suit. I just want to make sure this MD never does this to another person again! She definitely put my life in jeopardy by not only discharging me with a sub therapeutic INR, but not discharging me on the proper medications and making sure that things were followed as they should have been. She refused to order another PT/INR for the following day, and my INR ended up at 6.6. She knew from the hospitalization with the initial PE's, my INR was not stable at all. I was all over the place.

Thank you again, ecmst12!

 

[ecmst12]

Lya's point is that there is a good chance your insurance isn't going to pay for the treatment of your hospital-borne illnesses either. It's not an excuse for you being discharged inappropriately, but it could be a reason.

Logic tells me that all complaints are taken seriously. I don't believe you will be informed as to the type of action that is taken, though.

 

[abaga]

Hi ecmst12....

I had Coag Negative Staph, which is the staph on our skin from my understanding. My Insurance has paid for this, and they also paid for the PE's and DVT.

Thank you again for your help, input and understanding. You, along with a few others I have known over the years I have visited this board, are always extremely helpful and knowledgeable.

Lya's point is that there is a good chance your insurance isn't going to pay for the treatment of your hospital-borne illnesses either. It's not an excuse for you being discharged inappropriately, but it could be a reason.

Logic tells me that all complaints are taken seriously. I don't believe you will be informed as to the type of action that is taken, though.